PURPOSE The perioperative management of patients who are receiving antithrombotic (antiplatelet or anticoagulant) therapy and require urologic surgery is challenging due to the inherent risk for surgical bleeding and the need to minimize thromboembolic risk. The aim of this review is to assess the quality and consistency of clinical practice guidelines (CPGs) and clinical practice recommendations (CPRs) on this topic, and to summarize the evidence and associated strength of recommendations relating to perioperative antithrombotic management. METHODS A pragmatic search of electronic databases and guidelines websites was performed to identify relevant CPGs/CPRs. The AGREE II (Appraisal of Guidelines for REsearch and Evaluation) instrument was used to assess the methodological quality and integrity of the CPGs. RESULTS The CPGs provided by the European Association of Urology (EAU), the American College of Chest Physicians (ACCP) and the European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and the CPRs provided by the International Consultation on Urological Disease (ICUD)/American Urologic Association (AUA) were retrieved and reviewed. The 3 CPGs were critically assessed using the AGREE II instrument. Inconsistent recommendations were provided based on the indication for antithrombotic medication, the antiplatelet/anticoagulant agent and the type of urological procedure. Based on the AGREE II tool for CPG assessment, the EAU CPGs scored higher (83.3 points) compared to the ESC/ESA (75 points) and ACCP CPG (66.7 points). CONCLUSION The perioperative management of antithrombotic therapy in urological patients is potentially challenging but inconsistent CPG of varying quality may create uncertainty as to best practices to minimize thromboembolic and bleeding risk.

中文翻译：

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泌尿外科实践中的围手术期抗血栓治疗（抗血小板和抗凝）：临床实践指南的重要评估和总结。

目的由于需要手术出血的内在风险和需要将血栓栓塞风险降至最低的原因，正在接受抗血栓治疗（抗血小板或抗凝）治疗且需要泌尿外科手术的患者的围手术期管理具有挑战性。这篇综述的目的是评估有关该主题的临床实践指南（CPG）和临床实践建议（CPR）的质量和一致性，并总结与围手术期抗血栓形成管理有关的建议的证据和相关强度。方法对电子数据库和指南网站进行实用搜索，以识别相关的CPG / CPR。AGREE II（研究与评估指南评估）工具用于评估CPG的方法学质量和完整性。结果由欧洲泌尿外科学会（EAU），美国胸科医师学会（ACCP）和欧洲心脏病学会/欧洲麻醉学会（ESC / ESA）提供的CPG，以及由国际泌尿外科咨询提供的CPR疾病（ICUD）/美国泌尿科协会（AUA）进行了检索和审查。使用AGREE II仪器对3种CPG进行了严格评估。根据抗血栓药物的适应症，抗血小板/抗凝剂和泌尿外科程序的类型，提供了不一致的建议。基于AGREE II的CPG评估工具，EAU CPG得分高于ESC / ESA（75分）和ACCP CPG（66.7分）（83.3分）。